45 INDIVIDUALS AND ONE CORPORATION CHARGED AS PART OF NATIONWIDE OPERATION BY HEALTH CARE FRAUD PREVENTION AND ENFORCEMENT ACTION TEAMS (HEAT)

45 INDIVIDUALS AND ONE CORPORATION CHARGED AS PART OF NATIONWIDE OPERATION BY HEALTH CARE FRAUD PREVENTION AND ENFORCEMENT ACTION TEAMS (HEAT)

September 7, 2011

FOR IMMEDIATE RELEASE

91 Defendants Charged Nationally for Submitting More than $295 Million in Fraudulent Billing

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, and Christopher Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), announced charges against forty-five (45) individuals and one corporation as part of a nationwide enforcement operation by HEAT Task Force Teams. The 46 South Florida defendants are allegedly responsible for more than $160 million in false billings to Medicare.

In addition, as part of a coordinated national HEAT health care fraud takedown, the Department of Justice announced that 45 additional defendants were charged by HEAT teams in other cities, including Detroit, Los Angeles, Brooklyn, Houston, Dallas, Chicago, and Baton Rouge. Collectively, the 91 defendants, including doctors, nurses, medical professionals, health care company owners and others charged in the indictments and complaints, are accused of conspiring to submit a total of more than $295 million in fraudulent billing.

The joint Department of Justice-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. Over the course of the past week, approximately 400 law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the takedown. In addition to making arrests, agents also executed 18 search warrants in connection with ongoing strike force investigations.

U.S. Attorney Wifredo A. Ferrer stated, “The South Florida defendants, including clinic owners, a doctor, a nurse, mental health and family counselors, and patient recruiters, engaged in more than $160 million in Medicare fraud. In a new twist to the ever-changing Medicare fraud schemes, some of the defendants went as far as to recruit vulnerable out of state Medicare patients who were down on their luck or suffering from drug or alcohol addiction. The defendants promised the patients a roof over their heads in halfway houses as long as they received community mental health services that they did not need. If the patients refused the treatments, they were threatened with eviction and thrown out on the street. This conduct is outrageous and will not be tolerated. We will continue to fight the battle against health care fraud on all fronts, whether in community mental health care, home health care, HIV-infusion therapy, and durable medical equipment fraud.”

“The defendants charged in this takedown are accused of stealing precious taxpayer resources and defrauding Medicare - jeopardizing the integrity of our health care system and our nation’s most critical health care program for personal gain,” said Attorney General Holder. “Our highly coordinated, nationwide Strike Force operations are working aggressively to combat Medicare fraud and our anti-health care fraud efforts have never been more innovative, collaborative, aggressive - or effective. We will continue to work with our law enforcement partners and partners across government to fight against health care fraud.”

“South Florida is ground zero for health care fraud. The FBI and its partners devote vast resources to investigate, catch and prosecute those committing health care fraud,” said John V. Gillies, Special Agent in Charge of the FBI’s Miami Office. “To attack the problem from both ends, tougher regulation and oversight are key to reducing the amount of fraud in the first place.”

HHS-OIG Special Agent in Charge Christopher B. Dennis stated, “These 45 indicted individuals are representative of the OIG’s commitment to root out Medicare fraud in South Florida. The OIG will continue to identify, locate, and charge those responsible for stealing from the Medicare trust fund and ultimately the American taxpayer.”

The South Florida cases announced as part of the nationwide HEAT Enforcement Operation include:

United States v. Antonio Macli, et al.
United States v. Rufus Cargile
United States v. John Jackson
United States v. Sabrina Pressley

In these four separate cases, a total of twenty-three (23) individual defendants and one corporation (Biscayne Milieu) are charged with conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive health care kickbacks, payment and receipt of health care kickbacks, conspiracy to launder money, and money laundering in connection with the operation of Biscayne Milieu Health Center, Inc. (Biscayne Milieu), a community mental health center. According to the charges, Biscayne Milieu purported to provide a partial hospitalization program (PHP) for Medicare beneficiaries suffering from mental illnesses. In fact, however, the defendants devised a scheme in which they paid patient recruiters and even doctors to refer ineligible Medicare beneficiaries to Biscayne Milieu for purported PHP services. Indeed, some of the patients admitted to Biscayne Milieu were not eligible for PHP because they suffered from severe dementia or Alzheimer’s disease and would not benefit from group therapy. The indictment alleges that from January 2007 to June 2011, Biscayne Milieu submitted more than $50 million in fraudulent claims. This case is being prosecuted by Assistant U.S. Attorney Alicia Shick.

United States v. Ramchand Ramrup
United States v. Joseph B. Williams, et. al.
United States v. Robert Jenkins, et. al.
United States v. Robert Revels, et. al.
United States v. Barry Nash
United States v. Isabel Roque
United States v. Irene Trematerra

In this group of cases, ten (10) defendants were charged with conspiracy to commit health care fraud, conspiracy to receive and pay health care kickbacks, and receipt of health care kickbacks. According to court documents, from 2005 through 2010, the defendants variously participated in a fraudulent scheme orchestrated by the owners and operators of American Therapeutic Corporation (ATC) and its management company, Medlink Professional Management Group Inc. (Medlink). ATC purportedly provided partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando. ATC’s owners and operators purportedly paid kickbacks to owners and operators of assisted living facilities, including, for example, Boynton Beach Assisted Living Facility, in Boynton Beach, and Avondale Manor Retirement Home, in Pompano Beach, and halfway houses and to other patient recruiters. In exchange, the defendants delivered ineligible Medicare beneficiaries to ATC. Throughout the course of the fraudulent scheme, ATC billed Medicare more than $200 million for the medically unnecessary services and for services that were never provided. These cases are being prosecuted by Acting Assistant Chief Benjamin Singer and Trial Attorneys Steven Kim and Jennifer Saulino of the Department of Justice, Criminal Division, Fraud Section.

United States v. Marietha Morales, et. al.
United States v. Ariel Rodriguez, et al.
United States v. Roberto Gonzalez, et. al.

In these related cases, nine (9) defendants were charged with conspiracy to commit health care fraud and conspiracy to pay health care kickbacks. According to the charges, the defendants owned and operated home health care agencies that purported to provide home health care to homebound Medicare beneficiaries who were insulin-dependent but could not self-medicate. In fact, however, the defendants paid kickbacks to patient recruiters, who referred ineligible beneficiaries to the defendants’ home health companies. The defendants obtained fraudulent prescriptions and other medical documentation ordering home health services for the beneficiaries and falsified documentation indicating that the services had been provided. In fact, the beneficiaries did not require or receive home health services.

In this way, three home health companies owned and operated by the defendants billed Medicare for more than $100 million. More specifically, Prime Home Health, operated by defendants Marietha Morales and Eduardo Dominguez, submitted approximately $22 million in false Medicare claims for services purportedly provided to approximately 500 beneficiaries from April 2007 through April 2011. Serendipity Home Health, operated by defendants Ariel Rodriguez, Reynaldo Navarro, Melissa Rodriguez and Ysel Salado, submitted approximately $21 million in false Medicare claims for services purportedly provided to approximately 519 beneficiaries from April 2007 through March 2009. Nany Home Health, operated by defendants Roberto Gonzalez, Olga Gonzalez, and Fabian Gonzalez, submitted approximately $60 million in false Medicare claims for services purportedly provided to approximately 1474 beneficiaries from January 2006 through November 2009. These cases are being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Department of Justice, Criminal Division, Fraud Section.

United States v. Maratib Hashmi

Maratib Hashmi, of Miami, Florida, is charged with conspiracy to commit health care fraud, health care fraud, and money laundering. According to the indictment, Hashmi operated L’Image Physical Therapy and Rehabilitation, Inc., a Miami-Dade medical clinic that purportedly provided physical and occupational therapy to Medicare beneficiaries. From September 2009 through March 2010, Hashmi submitted approximately $1.2 million in false Medicare claims for outpatient physical and occupational therapy purportedly provided by L’Image. This case is being prosecuted by Assistant U.S. Attorney Adam Schwartz.

United States v. Clara Luz Varona

Clara Luz Varona, of Miami, is charged with conspiracy to commit health care fraud and health care fraud. According to the indictment, Varona co-owned A&C Medical Supplies Inc., a Miami-Dade durable medical equipment company that purportedly provided medical supplies to Medicare beneficiaries. The indictment alleges that between January 2005 and July 2009, Varona submitted false Medicare claims for approximately $1.8 million in medical supplies purportedly provided by A&C. Based on these claims, Medicare paid A&C approximately $1.1 million. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.

United States v. Oscar Hernandez

Oscar Hernandez, of Miami, is charged with conspiracy to commit money laundering. According to the Information, from May 2009 to June 2009, Hernandez assisted the owners of two fraudulent durable medical equipment companies by laundering $316,750 in Medicare fraud proceeds by cashing corporate checks made out to phony shell corporations. Hernandez received a percentage of the cashed checks as his fee. This case is being prosecuted by Assistant U.S. Attorney Chris Clark.

United States v. Reina Addis Masson

Reina Addis Masson, of Hialeah Gardens, is charged with conspiracy to commit health care fraud, health care fraud, conspiracy to receive and pay health care kickbacks, and receipt of health care kickbacks. The indictment alleges that Masson worked at A’s Medical Center (“AMC”), a medical clinic that purported to treat HIV positive Medicare beneficiaries. From October 2005 to December 2006, AMC submitted approximately $4.1 million in false claims for treatment of HIV therapy. Based on these claims, Medicare paid AMC approximately $700,000. At various times, Masson worked as a medical assistant, a patient recruiter, and a biller for AMC. This case is being prosecuted by Economic Crimes Deputy Chief Marc Osborne.

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG.

An indictment or information is merely a charge and defendants are presumed innocent until proven guilty.

Anyone with information regarding their whereabouts should call the FBI in Miami at (305) 944-9101.

Attachments:
Eduardo Dominguez (JPG)
Debora De Jesus (JPG)
James Wynn (JPG)

A copy of this press release may be found on the website of the United States Attorney's Office for the Southern District of Florida at http://www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at http://www.flsd.uscourts.gov or onhttp://pacer.flsd.uscourts.gov.

Technical comments about this website can be e-mailed to the Webmaster. PLEASE NOTE: The United States Attorney's Office does not respond to non-technical inquiries made to this website. If you wish to make a request for information, you may contact our office at 305-961-9001, or you may send a written inquiry to the United States Attorney's Office, Southern District of Florida, 99 NE 4th Street, Miami, Fl. 33132.

Operator Of Defunct Medical Labs Sentenced In Medicaid Fraud Scheme

Operator Of Defunct Medical Labs Sentenced In Medicaid Fraud Scheme

The former operator of medical laboratories in East Hartford and West Hartford was sentenced today to serve two years in prison and ordered to pay $20,000 restitution for billing the government for lab tests and other services that were never provided.

TAHIR SAEED SHERANI, age 46, formerly of South Orange, New Jersey, was sentenced in Hartford Superior Court, G.A. No. 14, by the Honorable Judge Elpedio N. Vitale to two years imprisonment and ordered to pay $20,000 restitution.

Mr. Sherani pled guilty in July to one count of Larceny in the First Degree By Defrauding A Public Community and one count of Attempted Larceny in the First Degree By Defrauding A Public Community, both class B felonies.

Mr. Sherani operated American Diagnostic Laboratories, Inc., in East Hartford and Immediate Medical Care, Inc., in West Hartford, until the businesses were shut down by federal and state authorities in 2003. Mr. Sherani subsequently moved to California, where he was convicted in 2005 of defrauding that state's Medicaid program.

In 2010 Mr. Sherani was returned to Connecticut to face charges involving more than 3,800 false claims for Medicaid reimbursement for services that were never provided. Medicaid is a government-funded health care program that serves low-income individuals.

The case was prosecuted by the Medicaid Fraud Control Unit in the Chief State's Attorney's Office. The unit is grateful for the assistance it received in this investigation from the State of Connecticut Department of Social Services Office of Quality Assurance, the Federal Bureau of Investigation, the Office of the Inspector General of the U.S. Department of Health and Human Services and the West Hartford and Windsor Locks Police Departments.

Medicare Fraud Strike Force Charges 91 Individuals for Approximately $295 Million in False Billing 

U.S. Department of JusticeSeptember 07, 2011

Office of Public Affairs(202) 514-2007/TDD (202)514-1888

WASHINGTON—Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that a nationwide takedown by Medicare Fraud Strike Force operations in eight cities has resulted in charges against 91 defendants, including doctors, nurses, and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $295 million in false billing.

Attorney General Holder and Secretary Sebelius were joined in the announcement by FBI Executive Assistant Director Shawn Henry, Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division, and HHS Inspector General Daniel R. Levinson.

As part of a coordinated action, 70 individuals were charged by Strike Force prosecutors in indictments unsealed yesterday and today in six cities alleging a variety of Medicare fraud schemes involving approximately $263.6 million in false billings. As part of takedown operations last week, 18 additional defendants were charged in Detroit and one defendant was charged in Miami in cases unsealed on Sept. 1, 2011, for their alleged roles in Medicare fraud schemes involving approximately $29.4 million in fraudulent claims. Additionally, two individuals are scheduled to appear in court today on charges filed on Aug. 24, 2011, for their roles in a separate $2 million health care fraud scheme. This coordinated takedown involved the highest amount of false Medicare billings in a single takedown in Strike Force history.

The joint Department of Justice-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. Over the course of the past week, approximately 400 law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the takedown. In addition to making arrests, agents also executed 18 search warrants in connection with ongoing strike force investigations.

“The defendants charged in this takedown are accused of stealing precious taxpayer resources and defrauding Medicare – jeopardizing the integrity of our health care system and our nation’s most critical health care program for personal gain,” said Attorney General Holder. “Our highly coordinated, nationwide Strike Force operations are working aggressively to combat Medicare fraud and our anti-health care fraud efforts have never been more innovative, collaborative, aggressive – or effective. We will continue to work with our law enforcement partners and partners across government to fight against health care fraud.”

“Today’s arrests are a powerful warning to those who would try to defraud taxpayers and Medicare beneficiaries,” said HHS Secretary Sebelius. “These arrests illustrate close cooperation between the Medicare program that identified these fraudsters and the law enforcement officials who acted swiftly to cut them off. And our efforts to stop criminals don’t end here because the Affordable Care Act gives us new tools to prevent Medicare fraud before it is committed – better protecting seniors and the integrity of the Medicare program for generations to come.”

The defendants charged are accused of various health care fraud-related crimes, including conspiracy to defraud the Medicare program, health care fraud, violations of the anti-kickback statutes and money laundering. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, physical and occupational therapy, mental health services, psychotherapy, and durable medical equipment (DME).

According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided. In many cases, indictments and complaints allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided. Collectively, the doctors, nurses, medical professionals, health care company owners and others charged in the indictments and complaints are accused of conspiring to submit a total of approximately $295 million in fraudulent billing.

“The health care system is part of our nation’s infrastructure and we must do everything in our power to protect the integrity of Medicare and the system at large,” said FBI Executive Assistant Director Henry. “Working together as partners, we can stop criminals who seek to steal American taxpayers’ hard-earned dollars and we help ensure our nation’s health care system is there for those who need it.”

“As charged in these indictments, the defendants cover nearly the entire spectrum of health care providers, and perpetrated a variety of fraudulent schemes,” said Assistant Attorney General Breuer. “From Brooklyn to Miami to Los Angeles, the defendants allegedly treated the Medicare program like a personal piggy bank. Today’s Strike Force operations should serve as a wake-up call to would-be fraudsters nationwide. With Strike Force teams now in nine cities across the country, and employing sophisticated, data-driven law enforcement methods, we are determined to hold criminally responsible those who defraud Medicare.”

“The warning should be unambiguously clear by now,” said HHS Inspector General Levinson. “We will continue using the combined law enforcement might of Strike Forces around the country to combat health care fraud.”

In Miami, 45 defendants, including one doctor and one nurse, were charged today and yesterday for their participation in various fraud schemes involving a total of $159 million in false billings for home health care, mental health services, occupational and physical therapy, DME, and HIV infusion. Another defendant in Miami was charged on Sept. 1, 2011, for a $1 million Medicare fraud scheme. In one case, 24 defendants are charged for participating in a community mental health center fraud scheme involving more than $50 million in fraudulent billing. According to court documents, the defendants allegedly paid patient recruiters to refer ineligible beneficiaries to the mental health center. In some instances, beneficiaries who were residents of halfway houses were allegedly threatened with eviction if they did not agree to attend the mental health center.

This is done everyday in foster care.  If an original parent does "not agree to attend the mental health center", their parental rights shall be terminated.  The children in foster care have no choice.  They are automatically sent to mental health services, well, at least on paper they are.

Same fraud scheme.  Different age population.

In Houston, two individuals were charged today with fraud schemes involving $62 million in false billings for home health care and DME. According to an indictment, one defendant allegedly sold beneficiary information to 100 different Houston-area home health care agencies in exchange for illegal payments. The indictment alleges that the home agencies then used the beneficiary information to bill Medicare for services that were unnecessary or never provided.

Ten defendants were charged in Baton Rouge, La., for participating in schemes involving more than $24 million related to false claims for home health care and DME. According to one indictment, a doctor, nurse, and five other co-conspirators participated in a scheme to bill Medicare for more than $19 million in skilled nursing and other home health services that were medically unnecessary or never provided.

Six defendants, including two doctors, were charged in Los Angeles for their roles in schemes to defraud Medicare of more than $10.7 million. In Brooklyn, three defendants, including two doctors, were charged for a fraud scheme involving more than $3.4 million in false claims for medically unnecessary physical therapy. Two defendants, including a doctor, are making initial appearances today in U.S. federal court in Dallas after being charged for a scheme to defraud Medicare of approximately $2.1 million.

In Detroit, 18 defendants, including three doctors, were charged last week for schemes to defraud Medicare of more than $28 million. According to an indictment, 14 of the defendants participated in a home health care scheme that submitted more than $14 million in false claims to Medicare.

Finally, four defendants including one doctor, were charged in Chicago for their alleged roles in schemes to defraud Medicare of more than $4.4 million.

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.

Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

The cases announced today are being prosecuted and investigated by Medicare Fraud Strike Force teams comprised of attorneys from the Fraud Section of the Justice Department’s Criminal Division and from the U.S. Attorney’s Offices for the Southern District of Florida, the Eastern District of Michigan, the Eastern District of New York, the Southern District of Texas, the Central District of California, the Middle District of Louisiana; the Northern District of Illinois, and the Northern District of Texas; and agents from the FBI, HHS-OIG, and state Medicaid Fraud Control Units.

An indictment is merely a charge and defendants are presumed innocent until proven guilty.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.

Miami Woman is 10th Person Arrested for Her Role in Leading $27 Million Health Care Fraud Conspiracy

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; and Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Office of Investigations, announced today’s arrest of Elizabet Lombera, 39, of Miami Lakes, Florida. On August 4, 2011, a federal grand jury in Miami indicted Lombera with one count of conspiracy to commit health care fraud, in violation of Title 18, United States Code, Section 1349, six counts of health care fraud, in violation of Title 18, United States Code, Section 1347, and six counts of aggravated identity theft, in violation of Title 18, United States Code, Section 1028A, Case No. 11-20528-Cr-Seitz.

If convicted, the defendant faces a possible maximum statutory sentence of 10 years’ imprisonment on the conspiracy and the health care fraud counts. In addition, each count of aggravated identity theft carries a two-year mandatory minimum term of imprisonment to run consecutive to any other sentence.

According to the indictment, Lombera and her co-conspirators installed nominee presidents to hide her control of five durable medical equipment companies in Miami that submitted fraudulent claims to Medicare, including Mercy Medical Supply, Inc., JHH Group, Inc., La Numero 1 Farmacia Discount Corp., Yani’s Pharmacy, Inc., and El Perimetro Farmacia Discount Corp. Collectively, these five companies submitted approximately $27,383,328 in fraudulent claims to Medicare and received $12,438,952 in reimbursements. The indictment alleges that Lombera used the proceeds for personal gain, including paying for a trip to Japan.

Six of Lombera’s co-conspirators have already been sentenced for their roles in this conspiracy. Maykel Diaz Escalona, the nominee owner of Mercy Medical Supply, Inc., was sentenced to 37 months’ imprisonment inUnited States v. Maykel Diaz Escalona, Case No. 09-Cr-20084-Graham. Marcelino Avila, the nominee owner of JHH Group, was sentenced to 46 months’ imprisonment, in United States v. Marcelino Avila, Case No. 08-20730-Cr-Seitz. Douglas Reina, the nominee owner of Yani’s Pharmacy, was sentenced to 37 months’ imprisonment in United States v. Douglas Reina, Case No. 08-Cr-20330-Huck. Obel Martinez was sentenced to 36 months’ imprisonment for laundering approximately $620,000 of health care fraud proceeds in United States v. Obel Martinez, Case No. 10-Cr-20546-King. Emilio Bezanilla was sentenced to 30 months’ imprisonment for laundering approximately $195,000 in United States v. Emilio Bezanilla, Case No. 11-Cr-20096-Lenard. Finally, Edisnel Diaz Soler was sentenced to 27 months’ imprisonment for laundering approximately $580,000 of health care fraud proceeds in United States v. Edisnel Diaz Soler, Case No. 10-Cr-20876-Huck.

Four other individuals have been charged. Luis Fuentes, the nominee owner of El Perimetro, was charged in United States v. Luis Fuentes, Case No. 08-Cr-20199-Martinez, but remains a fugitive. Eliezer Lazo, Joel Martinez Hernandez, and Casimiro Martinez have been arrested and charged separately for their roles in laundering the proceeds of the health care fraud and are awaiting trial in United States v. Eliezer Lazo, Case No. 11-20447-Cr-Altonaga; United States v. Joel Martinez Hernandez, Case No. 11-20446-Cr-Moreno; and United States v. Casimiro Martinez, Case No. 11-Cr-20448-Jordan.

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. These case are being prosecuted by Assistant U.S. Attorney H. Ron Davidson and Trial Attorney O. Benton Curtis of the Criminal Division’s Fraud Section.

An indictment is only an accusation and a defendant is presumed innocent until and unless proven guilty beyond a reasonable doubt.

Miami-Area Psychiatrist Pleads Guilty for Role in $200 Million Medicare Fraud Scheme

Miami-Area Psychiatrist Pleads Guilty for Role in $200 Million Medicare Fraud Scheme

WASHINGTON - A Miami-area psychiatrist pleaded guilty today in U.S. District Court in Miami for his part in a fraud scheme that resulted in the submission of more than $200 million in fraudulent claims to Medicare, the Department of Justice, FBI and Department of Health and Human Services (HHS) announced.

Dr. Alan Gumer, 64, of Tamarac, Fla., pleaded guilty to one count of conspiracy to commit health care fraud.   Gumer was charged on Feb. 15, 2011, with one count of conspiracy to commit health care fraud and four counts of health care fraud.

According to court documents, Gumer was a psychiatrist at American Therapeutic Corporation (ATC), a Florida corporation headquartered in Miami.   ATC purported to operate partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando.  A PHP is a form of intensive treatment for severe mental illness.

Gumer admitted that he signed evaluations, notes and other documents in medical files for patients who did not need the treatment for which ATC billed Medicare.   Specifically, as a psychiatrist, Gumer knew that the patients attending ATC did not need intensive mental health treatment, and that the treatments offered by ATC were not the type of intensive treatments a PHP should provide.   Gumer admitted that he signed these files without examining the patients, or writing and reading the statements he was signing.   Gumer also admitted to writing prescriptions for psychiatric medications for patients who did not need them in order to make it appear to Medicare that the patients qualified for PHP treatment.   According to court documents, Gumer also referred hundreds of ATC patients to a related company, the American Sleep Institute (ASI), for unnecessary diagnostic sleep disorder testing.

According to court filings, Gumer’s co-defendants and ATC’s owners and operators paid kickbacks to owners and operators of assisted living facilities (ALFs) and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI.  In some cases, the patients received a portion of those kickbacks.  Throughout the course of the ATC and ASI conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries, who did not qualify for PHP services, to attend treatment programs that were not legitimate PHP programs so that ATC and ASI could bill Medicare for more than $200 million in medically unnecessary services.

According to the plea agreement, Gumer’s participation in the fraud resulted in $19.3 million in fraudulent billing to the Medicare program.   Sentencing for Gumer is scheduled for Jan 19, 2012.  Gumer faces a maximum of 10 years in prison and a $250,000 fine. 

ATC, its management company Medlink Professional Management Group Inc., and the owners and lead manager of ATC, Medlink and ASI, were charged with various health care fraud, money laundering and other offenses in a separate superseding indictment unsealed on Feb. 15, 2011.   Two of the three owners and the lead manager, as well as both ATC and Medlink, have pleaded guilty and have admitted to the fraudulent scheme and that more than $200 million in billings were submitted to the Medicare program as a part of the scheme.   They are scheduled for sentencing on Sept. 14, 2011, by U.S. District Court Judge James Lawrence King.   The trial of the third owner charged in the separate superseding indictment is scheduled to begin on Aug. 15, 2011.  

The remaining 17 co-defendants named in the indictment in which Gumer was charged are scheduled to stand trial on Nov. 7, 2011, before U.S. District Judge Patricia A. Seitz.

An indictment is merely an accusation and defendants are presumed innocent unless and until proven guilty in a court of law.

         

Today’s guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; John V. Gillies, Special Agent-in-Charge of the FBI’s Miami field office; and Special Agent-in-Charge Christopher Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami office. 

         

The criminal case is being prosecuted by Trial Attorney Jennifer L. Saulino of the Criminal Division’s Fraud Section.  The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.

         

Since its inception in March 2007, the Medicare Fraud Strike Force operations in nine locations have charged more than 1,000 defendants that collectively have billed the Medicare program for more than $2.3 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG are taking steps to increase accountability and decrease the presence of fraudulent providers.

How Not To Hide A Secret Love Child - Baby LK Report For May 29th 2011

Baby LK recaps the week in news for the child protection industry.

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SCOTUS Continues To Strips Whistleblowers of Whistles

The relator approaches the court, on behalf of the United States, on a mission, fearful of those horrible tales of loosing every chance of hope of being made whole again.  Out of the darkness of the legal forest, lurking, are the public disclosure bars of "persons, administrative, reports". Oh my.

At any time, the Court will crush you using one of these "interpretive buttresses" snatched off the Magna Carta, to beat you down and make you and your children go back to the fields and pick tomatoes and lettuce.  (Well, that is the goal once all the anchor babies are cleaned out of the country to give these great jobs to hard working, cheaper laboring American children.)

First the Supreme Court of the United States (SCOTUS) says, "Even though all the other laws say a State is a person, we don't think so when it comes to States allowing federal programs to be ripped off under the False Claims Act because it would be too embarrassing for the us because we allowed the States to do whatever they wanted when we give them money, and besides, the States never had to be held to fraud standards before in federal contracts and the Congress was never clear in its intent for the States to be considered as 'persons'."

How dare some average person dare think they have the entitlement right to challenge us!  We are the great Supreme Court of the United States!  Poor people have no rights and definitely no right to sue and get rich.

SCOTUS False Claims Act Opinion of Justice Scalia

There was a lone dissent which believed States were intended by the Congress to be considered as "persons".
SCOTUS Stevens False Claims Act Dissent in Vermont Agency of Natural Resources v. U.S. ex rel. Stevensre

Then came another shaving of the qui tam when SCOTUS decided anything "administrative" fell under the "public disclosure bar" meaning any state or federal report, hearing, audit, or anything else as such are not allowed to be used by an original source.
Supreme Court of the United States GRAHAM COUNTY SOIL AND WATER CONSERVATION DISTRICT et al., Petitioners...

But wait, SCOTUS, as well as those whose corporations make substantial killings, literally, bilking Medicaid in child welfare, decided that anything requested through a Freedom of Information of Act request falls under the "public disclosure bar".

Let's pretend this actually happened:

I walk into the residential institution where my child incarcerated after being ripped from his bed in the middle of the night for no reason beyond child protective services and the police going to the wrong address, is being tortured and, with a fake smile I politely ask for his IEP.  They hand it to me and it states he is considered "ineligible" for special needs, institutionalization and does not need medication, yet he is locked up in solitary confinement, beaten, raped, tortured, drugged suffering multiple heart attacks, tardive dyskensia, attempted suicides, surviving from meals of dried bread and potatoes with no heat in the winter or air conditioning in the summer, with different dates of birth on the court reports submitted to the court because my child was under aged for the facility.

Then, I go the office of the clerk of the court and pull his child protective services case and find out they fabricated a story of a car crash that never took place and had a duplicate fake case as a juvenile delinquent and were not just double billing, but billing me as a juvenile delinquent, also.

So I go and file a FCA and the court says: "So sorry, those are public docs and therefore, the States can do whatever the fuck they want to do and there is nothing that will ever be done because we only cater to the rich."

Let's keep pretending this did not happen, either.
Supreme Court of the United States SCHINDLER ELEVATOR CORPORATION, Petitioner, v. UNITED STATES ex rel. Dan...

"Qui tam pro domino rege quam pro se ipso in hac parte sequitur!"

Being a whistleblower and reporting fraud is a right of free speech.  Verifying it through FOIA requests makes an original source the subject matter expert.  I dare anyone to challenge, publicly of course, my expertise in child welfare fraud, even SCOTUS.